Sputum smear positive tuberculosis among pulmonary tuberculosis patients at university of maiduguri teaching hospital: a retrospective study

The identification of sputum smear positive pulmonary tuberculosis cases is recommended by the World Health Organisation (WHO) as part of its directly observed therapy short course (DOTs) for effective global tuberculosis control. Earlier study performed in this centre (University of Maiduguri Teaching Hospital (UMTH) Maiduguri) showed a relatively small prevalence of sputum smear positivity among Pulmonary Tuberculosis (PTB) patients that is not close to the Millennium Development Goals (MDG). Objectives: To determine the prevalence of sputum smear positive tuberculosis and assess the progress so far, 5 years after the earlier study. Methods: This is a retrospective study, where the records of all patients treated for tuberculosis at UMTH between April 2008 and December 2008 were retrieved and analysed. Demographic data of PTB patients and their results of sputum smear, stained by Ziehl-Neelson technique were obtained. The effect of HIV seropositivity and of its treatment using HAART on sputum smear was assessed. Results: Four hundred and thirty nine patients with PTB aged 14 years and above consisting of 254(57.9%) males and 185(42.1%) females were used for this study. The 20-25 year age group had the highest sputum smear positive cases, while those within the 62-67 year age group had the lowest. One hundred and eight patients (41.4%) had sputum smear positive results while 153(58.6%) patients had negative smears. Nosignificant difference in sputum positivity between HIV negative and HIV positive patients. Conclusion: The higher rate of sputum smear positive pulmonary TB cases showed an increase in detection rate compared with an earlier finding, but is still some miles away from the set target (MDG goals)

Radiographic Features of Pulmonary Tuberculosis Among HIV Patients in Maiduguri, Nigeria

Background: Tuberculosis infection may develop at any stage of HIV infection. Pulmonary tuberculosis produces a broad spectrum of radiographic abnormalities among HIV patients. Method:A cross-sectional study of the radiographic features of pulmonary tuberculosis in 60 consecutive confirmed HIV-seropositive patients aged between 18 and 55 years (Mean \ub1 SD: 33.9 \ub1 8.42) comprising of 34 males and 26 females. Chest x-rays were evaluated for the presence of apical opacities with or without cavitation (typical) or miliary, lower or mid-zone and reticulonodular opacities, pleural effusion, hilar adenopathy and normal radiograph (atypical). Results:The commonest clinical manifestation was productive cough (100%). Oral thrush (87%), weight loss (83%), night sweats (78%), fever (75%), chest pain (50%) and herpes zoster (5%) also occurred in the patients. Normal radiographs constitute the commonest radiographic finding and were seen in 15 (25%) patients. Hilar adenopathy was noted in 5 (8%) patients. Pleural effusion was seen in 10 (16.7%) patients (mean 194.5 \ub1 82.9/\u3bcl). Lower/mid-zone and reticulonodular opacities occurred in 7 (11.6%) and 2 (3%) patients respectively. Conclusion: Majority of patients in our study had normal chest radiographs. Absence of changes in chest radiographs should not exclude the diagnosis of PTB.Fond: L'infection de tuberculose peut se d\ue9velopper \ue1 n'importe quelle \ue9tape de l'infection par le HIV. La tuberculose pulmonaire produit un large \ue9ventail des anomalies radiographiques parmi des patients d'VIH. M\ue9thode: Une \ue9tude transversale des dispositifs radiographiques de latuberculose pulmonaire dans 60 malades de VIH-s\ue9ropositifs cons\ue9cutifs et confirm\ue9s \ue2g\ue9s entre 18 et 55 ans (moyen \ub1 : 33.9 \ub1 8.42) comportant de 34 m\ue2les et de 26 femelles. Des radiographies de la poitrine ont \ue9t\ue9 \ue9valu\ue9es pour la pr\ue9sence des opacit\ue9s apicales avec ou sans la cavitation (typique) ou miliaire, bas ou mi-zone et opacit\ue9s reticulonodulaires, effusion pleurale, ad\ue9nopathie hilar et radiographie normale (atypiques). R\ue9sultats: La manifestation clinique la plus commune \ue9tait la toux productive (100%). La grive oral (87%), la perte de poids (83%), les sueur de la nuit (78%), la fi\ue8vre (75%), la douleur de poitrine (50%) et zoster d'herp\ue8s (5%) se sont \ue9galement produits dans les malades. Les radiographies normales constituent la conclusion radiographique la plus commune et ont \ue9t\ue9 vues dans 15 (25%) malades. Ad\ue9nopathie de hilar a \ue9t\ue9 not\ue9 dans 5 (8%) malades. L'effusion pleurale a \ue9t\ue9 vue dans 10 (16.7%) malades (\ub1 82.9/ de moyen 194.5ml). Bas/ mi-zone et des opacit\ue9s reticulonodulaires se sont produites dans 7 (11,6 %) et 2 (3%) malades respectivement. Conclusion: la Majorit\ue9 de malades dans notre \ue9tude avait les radiographies de poitrine normales. L'absence de changements dans les radiographies de poitrine ne doit pas exclure le diagnostic de PTB

Serum C-Reactive Protein in Nigerians With Type 2 Diabetes Mellitus

Background: C-reactive protein is an acute-phase proteins, produce in the liver, its release is stimulated by cytokines (interleukin 6 and tumour necrosis factor alpha). Elevated level of it is a risk factor for coronary heart disease. Baseline levels of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. Diabetics are at increased risk for coronary heart disease, data from the Framingham Study showed a two-to three-fold elevation in the risk of clinically evident atherosclerotic disease in patients with type II diabetes compared to those without diabetes. However, but data regarding CRP in Nigerian diabetic is lacking.Method: A cross-sectional study conducted among patients attending out patient clinic of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State south western Nigeria. Measurement of C-reactive protein was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA).Results: A total of 125 consecutive subjects were recruited comprising 75 patients with type II diabetes mellitus with or without hypertension and 50 apparently healthy age-and-sex comparable controls. There was a significant difference between the mean systolic and diastolic blood pressures of the patients and controls. The fasting blood glucose and C-reactive protein were significantly higher in diabetics compared to controls. There was a positive and significant correlation between FBG and CRP in both patients and controls. Conclusion: This study showed that diabetics have significantly higher serum C-reactive protein compared to the apparently controls. Also there was a positive and significant correlation between C-reactive protein and fasting blood glucose among both patients and controls

Seroprevalence of HIV and other sexually transmitted infections (STI 's) among commercial sex workers using lime/lemon juice for vaginal douching.

Aim: The objective is to establish the relationship between STD'S/ HIV infection and vaginal douching with lime/lemon juice among commercial sex workers.Method: 194 CSW's consented for this population base study in-depth interviews were conducted Pelvic examination was carried OUI, vaginal swabs were taken and samples of venous blood were collected for HIV serology test The data obtained from this study was analyse using simple percentage and chi square.Result : Vaginal douching wilh lime juice was practiced by 61.9% of the CSWs. The Sero-prevalence of HIV was higher among lime users 58(48.3%) than non users 29(39.2%). About half of those who were HIV positive usc a higher concentration of lime juice. Significant numbers of users are harbouring Trichomonas vaginalis 65%( P0.004) and Bacterial Vaginosis 58.3%(P0.0000) than non usersConclusion: Vaginal douching with lime/lemon juice is practiced by CSWs. but associated with higher prevalence of HIV/STls. To minimised the risks of HIV infection its used should be modified.Keyword : HIV, vaginal douching lime/lemonjuice commercial sex worker

Medical and dental students’ willingness to administer treatments and procedures for patients living with AIDS

Background. Nearly three decades after the discovery of the human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS)epidemics continue to pose significant challenges to low-income countries in sub-Saharan Africa.Objective. To assess medical and dental students’ willingness to perform specific techniques and procedures on people living with AIDS (PLWA).Methods. A survey was done among medical and dental students (N=304) at a Nigerian University using a 21-item questionnaire that elicitedresponses on sociodemographic characteristics and willingness to perform specific techniques and procedures. Analysis of variance (ANOVA) andan independent t-test were used to determine the influence of sociodemographic variables. Multiple regression analyses were used to determine the predictors of willingness.Results. The cohort of medical and dental students was willing to care for PLWA. Almost all medical students were either undecided or unwillingto perform mouth-to-mouth resuscitation. A higher proportion of dental students were either undecided or unwilling to assist during surgery, toothextractions and other procedures they considered to be invasive. More medical than dental students were willing to carry out surgical procedures.Previous personal encounters with AIDS patients, religion, and satisfaction with instructions influenced medical and dental students’ willingness tocare for PLWA, while knowing a family member living with AIDS (R2=0.22, p<0.001) was the strongest predictor of willingness to care for PLWA.Conclusion. Extensive use of clinical clerkships and exposure through direct experience are viable strategies necessary for optimising and enhancingmedical and dental students’ dispositions to perform procedures and care for PLWA

Sputum smear positivity among patients presenting to the dots clinic with chronic cough

Cough is one of the cardinal features of Pulmonary Tuberculosis (PTB). However, even in communities with high prevalence of TB, lung diseases other than TB appear to account for this symptom. Objective: To estimate the prevalence of sputum smear positivity among patients with TB who presented with complaints of chronic cough to the Directly Observed Therapy Short Course (DOTS) clinic at the University of Maiduguri Teaching Hospital, North Eastern Nigeria. Methodology: A cross sectional study was conducted at the University of Maiduguri Teaching Hospital (UMTH) Borno state, Northeastern Nigeria between September 2014 and January 2017. All patients (new or previously treated) who presented to the DOTS clinic of the UMTH with complaints of chronic cough and had screening for pulmonary TB using sputum smear microscopy were reviewed. The minimum and the maximum ages were 1 year and 85 years, respectively, and the mean age was 36.0 (SD=14.0) years. The mean age did not differ among the male and female patients (i.e.37.3 ± 14.4 vs 34.1 ± 13.2, p=0.78). The overall prevalence of sputum smear positivity for TB was 26.5%. Although majority of patients who were sputum smear positive for TB fell within the age groups 30-39 and 20-29 thus accounting for 42.6% and 28.7% respectively, however, there was no significant association between age of those with chronic cough and sputum smear positivity TB (p=0.80). Among those who were sputum smear positive, 24.3% were new cases and 2.2% were previously treated. Conclusions: Data were entered into a computer database and analyzed with SPSS version 20.0 statistical software. Results: This study showed a high prevalence of sputum smear positivity among suspected TB patients with complaints of chronic cough This could be explained by the fact that the DOTS strategy has improved the case detection of PTB in this community. All patients with chronic cough should be evaluated for PTB

Anthropometric correlates of insulin resistance: a study of healthy Nigerian adults in Maiduguri

Indices of obesity, especially abdominal adiposity have been shown to correlate positively with the components of the metabolic syndrome in several studies. Objectives: The aim of this study was to determine the correlation between anthropometric indices and insulin resistance in healthy subjects. Methods: A representative sample of 100 subjects aged 15 to 70 years was recruited for the study. Weight, height, waist circumference (WC) and hip circumference were measured, while body mass index (BMI) and waist-to-hip ratio (WHR) were calculated for each participant. Fasting blood samples were drawn for plasma glucose and plasma insulin concentrations, respectively. The values obtained were used to calculate insulin resistance using the Homeostasis Model Assessment Method for Insulin Resistance (HOMA-IR). Results: Insulin resistance (IR) was found in 25(25%) of the study subjects. There were significant andpositive correlations between waist circumference and HOMA-IR (r=+0.20, p<0.05), as well as between BMI and HOMA-IR(r=+0.19, p<0.05).Both anthropometric indices however, only predicted 4.1% and 3.9% of the variation in HOMA-IR, respectively. The correlation between WHR and HOMA-IR was positive but non-significant (r=+0.12, p>0.05). Conclusion: Waist circumference exhibited the strongest correlation with HOMA-IR, closely followed by BMI and WHR. We recommend that measurement of waist circumference should continue to be used as a screening tool for identifying individuals with insulin resistance in our setting

Hepatic transaminase and alkaline phosphatase enzyme levels in HIV/HBV co‑infected and HIV mono‑infected patients in Maiduguri, Nigeria

Background: Studies have shown that HIV‑HBV co‑infected patients have an increased risk of liver‑related morbidity and mortality compared to their HIV‑mono‑infected counterparts. Furthermore, it has been reported that HIV‑HBV co‑infected patients have a significantly high incidence of drug‑induced hepatotoxicity following commencement of HAART than HIV‑mono‑infected patients.Objectives: To compare the levels of aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALKPO4) enzyme levels between HAART naïve HIV‑HBV co‑infected patients and their HIV‑mono‑infected counterparts.Materials and Methods: A cross‑sectional descriptive study in which 142 newly diagnosed HIV/HBV co‑infected and HIV mono‑infected adults were investigated for alkaline aminotransferase, aspartate aminotransferase and alkaline phosphatase enzyme levels.Results: The study subjects comprised of 80 (56.3%) females and 62 (46.7%) males. The age range of the study population was 15‑65 years. The mean ages of male and female subjects were 45.5 ± 10.5 years and 39.1 ± 7.5 years respectively (P < 0.05). Sixty‑three (44.4%) study subjects were HIV/HBV co‑infected while 79 (55.6%) were HIV mono‑infected. The mean ALT enzyme level of HIV/HBV co‑infected subjects was significantly higher than that of HIV mono‑infected ones i.e., 42.12 IU/l vs. 27.86 IU/l, (P = 0.038). However, there was no statistically significant difference in the mean AST (30.14 IU/l vs. 29.09 IU/l, P = 0.893) and ALKPO4 (55.86 IU/l vs. 60.97 IU/l, P = 0.205) enzyme levels between HIV‑HBV co‑infected and HIV mono‑infected subjects albeit the two enzymes were moderately elevated in both categories of subjects.Conclusion: The significantly elevated ALT enzyme levels amongst HIV‑HBV co‑infected subjects suggest that HIV‑HBV co‑infected patients may have an increased risk of liver‑related morbidity and mortality than their HIV mono‑infected counterparts. Screening for serological markers of chronic HBV infection, as well as hepatic transaminase enzyme levels in all newly diagnosed HIV‑positive patients is therefore recommended before commencement of HAART.Keywords: Alkaline phosphatase enzyme, hepatitis B virus surface antigen, hepatic transaminase enzymes, human immunodeficiency virusNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Seroprevalence of IgG anti- T. Gondii antibody among HIV-infected patients in Maiduguri, north eastern Nigeria.

Background: Toxoplasma gondii infection is one of the commonest opportunistic infections in HIV-infected patients, with the fatal consequences of toxoplasmic encephalitis particularly in advanced disease. However, data regarding T.gondii infection in the setting of HIV/AIDS are scant in Nigeria. Objective: To determine the seroprevalence of T.gondii amongst HIV-infected patients as well as to determine the correlation between anti-T.gondii IgG titre and the CD4+ cell count/HIV-1 RNA viral load. Method: A cross sectional study in which a total of 190 subjects were involved i.e. 110 newly diagnosed HAART naïve HIV-positive patients and 80 apparently healthy HIV-negative age- and-sex matched controls that were selected by simple random sampling method. Results: The age range of the study population was 20-64 years. The mean ages of male subjects for both HIV-positives and controls were 37.52 ±8.20 years and 35.79 ±12.31years, respectively, (p= 0.462). On the other hand, the mean ages of female subjects for both HIV-positives and controls were 29.90 ±6.98 years and 32.30 ±10.29 years, respectively, (p=0.149). Twenty one subjects (19.1%) among HIV-positives and 1 (1.25%) HIV-negative tested positive for anti-T.gondii IgG, respectively, (p= 0.000). The prevalence rate ration of anti-T. gondii IgG of HIV positives compared to HIVnegatives was 15.28. Significant proportion of anti-T.gondii positive subjects presented with AIDS defining illnesses compared with their anti-T.gondii negative counterparts. Conclusion:The study has shown that anti-T.gondii IgG is about 15 times more prevalent among HIV positive patients compared to controls. Routine screening for T.gondii IgG anti-body is therefore recommended for all HIV-infected subjects at the facility as well as commencement of chemoprophylaxis against Toxoplasmic encephalitis in HIV-infected patients with CD4+ cell count of <100 cells/ml

Limited emergence of resistance to integrase strand transfer inhibitors (INSTIs) in ART-experienced participants failing dolutegravir-based antiretroviral therapy: a cross-sectional analysis of a Northeast Nigerian cohort

Background Due to the high prevalence of resistance to NNRTI-based ART since 2018, consolidated recommendations from the WHO have indicated dolutegravir as the preferred drug of choice for HIV treatment globally. There is a paucity of resistance outcome data from HIV-1 non-B subtypes circulating across West Africa. Aims We characterized the mutational profiles of persons living with HIV from a cross-sectional cohort in North-East Nigeria failing a dolutegravir-based ART regimen. Methods WGS of plasma samples collected from 61 HIV-1-infected participants following virological failure of dolutegravir-based ART were sequenced using the Illumina platform. Sequencing was successfully completed for samples from 55 participants. Following quality control, 33 full genomes were analysed from participants with a median age of 40 years and median time on ART of 9 years. HIV-1 subtyping was performed using SNAPPy. Results Most participants had mutational profiles reflective of exposure to previous first- and second-line ART regimens comprised NRTIs and NNRTIs. More than half of participants had one or more drug resistance-associated mutations (DRMs) affecting susceptibility to NRTIs (17/33; 52%) and NNRTIs (24/33; 73%). Almost a quarter of participants (8/33; 24.4%) had one or more DRMs affecting tenofovir susceptibility. Only one participant, infected with HIV-1 subtype G, had evidence of DRMs affecting dolutegravir susceptibility—this was characterized by the T66A, G118R, E138K and R263K mutations. Conclusions This study found a low prevalence of resistance to dolutegravir; the data are therefore supportive of the continual rollout of dolutegravir as the primary first-line regimen for ART-naive participants and the preferred switch to second-line ART across the region. However, population-level, longer-term data collection on dolutegravir outcomes are required to further guide implementation and policy action across the region